Table of Content

15 May 2016, Volume 35 Issue 3
Previous Issue    Next Issue
---
述评
热点问题
论著
综述
讲座


For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

Minimally Invasive Surgery for Tubal Infertility: the Past, Present and Future XIA En-lan 2016, 35 (3):  181-186.  Abstract ( 1531 )   PDF (996KB) ( 8372 )   Surgery is the main effective method for the treatment of fallopian tube occlusion. Hysteroscopy and laparoscopy lead the treatment of tubal infertility into the era of minimally invasive surgery. The accurate evaluation of tubal function helps to analyze the causes of infertility, which provides important clinical evidence for treatment. Laparoscopic, ultrasonographic examination and hysterosalpingography are useful methods to evaluate the status of fallopian tube. The development of 2D hysterosalpingo-contrast-sonography(2D-HyCoSy), 3D-HyCoSy and 4D-HyCoSy technologies make the evaluation of tubal lesion more accurate by observing the dynamic change of fallopian tube. The treatment of distal tube obstruction includes salpingostomy, salpingectomy, proximal tubal block, tubal embolization under hysteroscope, fimbrioplasty, proximal tubal block and salpingostomy for distal tube, under the guidance of ultrasound hydrosalpinx suction sclerosis therapy, and so on, all of which have their own indications. Tubal cannulation technique is an effective method for the treatment of proximal tubal obstruction, which is operated by means of laparoscopy, hysteroscopy, ultrasonography or radiation guidance. The combination of laparoscopy with hysteroscopy in the tubal cannulation is the most common method, which makes it to be possible to diagnose and treat simultaneously pelvic adhesions and endometriosis. In vitro fertilization is a complementary treatment of tubal surgery for infertile women with tubal occlusion. Falloscopy, robotic and 3D laparoscopy as well as COOK guide-wire are increasingly used in tubal reconstructive surgery, which are expected to increase the pregnancy rate. Related Articles | Metrics

述评

Select

Application of Tubal Endoscopic Surgery in Treatment of Tubal Infertility CHEN Ya-qiong;CHEN Jun;HOU Hai-yan;DONG Qu-long 2016, 35 (3):  187-190.  Abstract ( 1403 )   PDF (798KB) ( 7873 )   Tubal factors are the most infertile causes in female infertile women, including the proximal tubal obstruction, tubal sterilization, and distal fallopian adhesion, atresia and hydrosalpinx. Although assisted reproductive techniques have dominated in reproductive medicine at present, the reproductive surgery still plays a irreplaceable role. Comprehensively considering the age, ovarian reserve, tubal function after reproductive surgery and the partner′s semen parameters, the individualized reproductive surgery can be performed in those patients with surgery indications. The endoscopic surgical treatment not only usually brings satisfactory outcomes in the clinical pregnancy rate and the live birth rate, but also restores the potence of natural fertilization in some patients, which meets the fertility policy of China. Different procedures of endoscopic surgery , according to the different tubal lesions, can be selected, mainly including the proximal fallopian tube anastomosis, the tubal catheterization, the middle fallopian tube anastomosis, tubal adhesiolysis, fimbrioplasty, salpingostomy, salpingectomy and ligation. Related Articles | Metrics

热点问题

Select

The Treatment Strategy in Rebirth Patients with Diminished Ovarian Reserve MA Xiang;LIU Jia-yin 2016, 35 (3):  191-195.  Abstract ( 1581 )   PDF (903KB) ( 8025 )   With the universal two-child policy in China, a considerable part of the rebirth patients are coming into the age of ovarian reserve function decline (DOR) at present. DOR indicates the decreasing reaction to ovarian stimulation, the decreasing quality of oocyte, and the status of "hard to pregnancy and easy to abortion". It is very important to assess accurately and promptly the ovarian reserve of DOR rebirth patients. At present, the treatment strategy for DOR patients includes: ①Assisted reproductive technology(ART) is recommended actively, in which the mild stimulation, minimal stimulation or natural cycles is the increasing popular ART strategy in DOR patients; ②Growth hormones, weak androgens and antioxidants can be added to improve the clinical outcomes of in vitro fertilization (IVF); ③The clinical outcomes could be still unsatisfied for those aged DOR patients even if the donated egg IVF combined with reproductive engineering technology was used. Related Articles | Metrics

论著

Select

The Tubal Function Index Developed by Delphi Method was Used in Tubal Infertility HOU Hai-yan;LAN Xiao-xia;CHEN Jun;SUN Yang;CHEN Ya-qiong;YANG Zhen-hua 2016, 35 (3):  196-201.  Abstract ( 1531 )   PDF (957KB) ( 7967 )   Objective: To develop the index system, an estimative system for tubal function in patients with tubal infertility, which provide scientific evidence for the prognosis follow-up visit and the postoperative pregnancy guidance. Methods: According to the literature retrieval and our clinical practice, we designed the expert questionnaire. With this expert questionnaire, the index system was developed to evaluate the tubal function after reproductive surgery by the three-round Delphi method and analytic hierarchy method. Results: The authoritative degree after the three-round expert questionnaire was 0.426, with the statistical significance(P＜0.05). The Kendall coefficients of concordance of the first-dimension to the fifth-dimension were 0.625-0.630, 0.600-0.640, 0.595-0.630, 0.585-0.655 and 0.595-0.650. This index system was constituted with 2 first-dimension, 6 second-dimension, 19 third-dimension, 31 fourth-dimension and 33 fifth-dimension after three-round expert consultation. In all of the indices, the factor of tubal patency in tubal infertile patients after reproductive surgery had the highest weight (0.673). For the weight of tubal patency, it is higher in the bilateral than unilateral tubal patency, the original than recanalized patency, while it is the lowest in the bilateral obstruction. For the weight of tubal morphology, it is higher in the bilateral tubal patency with normal original morphology than others, the morphology and construction of fimbria than the relative location of tube and ovary, and the fimbria atresia than salpingostomy in hydrosalpinx, while it is higher in the peri-tubal adhesion than tubal angulation. For the weight of tubes with abnormal morphology after surgery, it is lower and lower from the fimbria without freedom, the continued abnormal fimbria after salpingostomy to the abnormal mucosa of hydrosalpinx. Conclusions: The index system developed by Delphi method for tubal function evaluation in tubal infertility is reliable and valid, which provide scientific suggestion for the reproductive surgical prognosis and guidance of postoperative pregnancy. Related Articles | Metrics

Select

New Application of Hysteroscopy: Replacement for Salpingoscopy CHEN Jun;HOU Hai-yan;CHEN Ya-qiong;CHEN Xiao;YANG Zhen-hua 2016, 35 (3):  202-204.  Abstract ( 1516 )   PDF (790KB) ( 7964 )   Objective: To explore the probability of hysteroscopy, replacing salpingoscopy, in tubal reconstructive surgery with infertility of hydrosalpinx. Methods: Data from 43 patients with infertility of hydrosalpinx who accepted operation in our hospital from January 2012 to August 2012 were retrospectively analyzed. All the patients received the conjunction of hysteroscopy with laparoscopy. Under hysteroscopy, we observed the tubal lumen, including adhesions, loss of mucosal folds, rounded edges of mucosal folds, debris, foreign bodies and abnormal vessels. The F score expressed the sum of the above abnormal results, each abnormal result was given one score. After linear salpingectomy or salpingostomy following the F score, a follow-up within 24 months was done, and the pregnancy rate and the live birth rate were recorded. Results: In 43 patients, 66 tubes were diagnosed as hydrosalpinx by laparoscopy, 8 tubes (F score≥2) were removed. The pregnancy rate was 45%（18/40）, and the live birth rate was 35%（14/40）. Conclusions: Hysteroscopy can be used to replace salpingoscopy to observe the tubal lumen, which can afford beneficial suggestion of hydrosalpinx therapy. Related Articles | Metrics

Select

Heterotopic Pregnancy after in Vitro Fertilization and Embryo Transfer：A Clinical Analysis of 10 Cases WENG Hui-nan;CHEN Ye;TANG Ting;RUAN Jian-xing;LIU Feng-hua 2016, 35 (3):  205-208.  Abstract ( 1564 )   PDF (774KB) ( 7948 )   Objective: To investigate the high risk factors，clinical characteristics and treatment of heterotopic pregnancy(HP) after in vitro fertilization and embryo transfer (IVF-ET)． Methods: Ten cases of HP after IVF-ET were analyzed retrospectively. Results: 9 of 10 HP patients suffered from tubal factor infertility. 8 of them had previous pelvic surgeries. 9 cases were diagnosed HP via ultrasound in the first visit. Operation was performed for all 10 cases，including 7 laparoscopes, 3 selective reductions. 8 patients got their healthy babies after operation. Conclusions: A history of tubal inflammatory disease and pelvic surgeries are the risk factors of HP. Transvaginal ultrasound is the first choice for HP diagnosis. Laparoscopy can be the safe and effective treatment for the HP of uterine pregnancy combined with heterotopic tubal or corneal pregnancy. Selective fetal reduction via transvaginal ultrasound can be recommended for the HP of uterine pregnancy combined with heterotopic cervical or cesarean scar pregnancy. Related Articles | Metrics

Select

Application of Laparoscopic Ovarian Puncture in Treatment of Polycystic Ovary Syndrome CHEN Xiao;CHEN Ya-qiong;GAO Xiu-xia;HOU Hai-yan 2016, 35 (3):  209-211.  Abstract ( 1493 )   PDF (819KB) ( 7903 )   Objective: To evaluate the therapeutic efficacy of laparoscopic ovarian puncture for those patients with clomiphene-resistant polycystic ovary syndrome(PCOS). Methods: Seventy-two women with clomifene-resistant PCOS were treated by laparoscopic ovarian puncture from Jan. 2010 to Mar. 2014. Laparoscopic ovarian paracentesis and hydrotubation were jointly performed. The levels of serum FSH, LH, E2, T and PRL were examined, while the ovarian volume and shape were observed before and after the operation. Postoperative ovulation was monitored by B-type ultrasound, and the pregnancy rate was followed up within 2 years after operation. Results: In 72 women with clomifene-resistant PCOS treated by laparoscopic ovarian puncture, ten cases with peritubal and ovarian adhesion were jointly treated by adhesiolysis. Two patients with unilateral tubal blocked were recanulated by the guidewire under hysteroscopy. The levels of LH and T in postoperative 2-month were significantly lower than those before operation (P＜0.05), while the ovarian volume was significantly decreased when compared with that before operation (7.852±3.763 cm3 vs. 11.773±6.553 cm3, t=2.974, P=0.009). The total natural ovulation rate was 61.11% (44/72), and the ovulation rate increased to 86.11% (62/72) when medical therapy was used as well. The cumulated pregnancy rate was 47.2% (34/72) within 24 months after operation. Conclusions: Laparoscopic ovarian puncture is a simple, mini-invasive and safe surgery, which is an alternative treatment for patients with drug-resistant PCOS. Related Articles | Metrics

综述

Select

Epidemiology and Etiology of Oviduct Infertility ZHU Hui-li;HUANG Wei 2016, 35 (3):  212-216.  Abstract ( 1348 )   PDF (826KB) ( 7959 )   The rising incidence of infertility among couples of childbearing age has been a global concern. The ovulatory and tubal factors are the common causes of female infertility, including the inflammation, adhesion and obstruction of oviduct. Pelvic inflammatory disease is the most common cause for oviduct infertility, which affected by Chlamydia trachomatis, Ureaplasma urealyticum, Gonococcus or tubercle bacillus. Besides, appendicitis, induced abortion, abdominopelvic surgery, endometriosis and congenital dysplasia of fallopian tube are also the pathogenesis of oviduct infertility. The prevalence of tubal infertility brings not only the great economic burden to the society, but also the psychological pressure to the patients. This systematic review on the epidemiology and etiology of tubal infertility may help doctors to optimize the prevention, diagnosis and treatment of tubal infertility. Related Articles | Metrics

Select

Clinical Practice in Ultrasonography of Fallopian Tube XIANG Yu-ting;BAI Wen-pei 2016, 35 (3):  217-220.  Abstract ( 1548 )   PDF (807KB) ( 7905 )   Nowadays, the prevalence of infertility is increasing. For infertile women, it is necessary to assess tubal patency. The gold standard of tubal patency assessment is laparoscopy with chromopertubation (LC). Hysterosalpingography (HSG), the most widely used technique, may cause iodine allergy and radiation exposure. Therefore, ultrasonography is expected as an alternative method of tubal patency assessment. At present, ultrasonography of fallopian tube consists of saline-infusion sonography (SIS), hysterosalpingo-contrast sonography (HyCoSy) and hysterosalpingo-foam sonography (HyFoSy), and HyCoSy is the most commonly used. Compared to traditional LC and HSG, HyCoSy shows accuracy and convenience while avoiding hospitalization, general anesthesia, radiation and iodine allgery, which makes it a promising technique in the future. Related Articles | Metrics

Select

Recanalization of Obstructed Proximal Fallopian Tube: A Review CHEN Jun;HOU Hai-yan;CHEN Ya-qiong 2016, 35 (3):  221-225.  Abstract ( 1451 )   PDF (826KB) ( 7898 )   The proximal tubal obstruction (PTO) remains an important cause of tubal infertility, including the plug of mucus and amorphous material, spasm of uterine oviduct, salpingitis isthmica nodosa, pelvic inflammatory disease and anatomic fibrosis occlusion by endometriosis. PTO can be successfully cannulated by the fallopian tube recanalization (FTR) with mechanical principle. The methods of FTR include selective salpingography and tubal catheterization (SSTC), hysteroscopic tubal catheterization, laparoscopy guided hysteroscopic tubal catheterization and falloposcopic tubal catheterization. Operator can select different surgical method according to his(her) qualification. The standard FTR should be the ternary conjunction of hysteroscopy, laparoscopy and falloposcopy. However, this ternary conjunction cannot be widely used in clinical practice due to the limitation of falloposcopy. The rate of natural pregnancy after FTR is equal to that of in vitro fertilization (IVF). FTR and IVF can be used as mutual complementary methods in the therapy of PTO. Related Articles | Metrics

Select

Treatment Challenges of Heterotopic Pregnancy WU Zhang-xin;MA Cai-hong 2016, 35 (3):  226-228.  Abstract ( 1400 )   PDF (756KB) ( 7916 )   Heterotopic pregnancy refers to the coexistence of intrauterine and ectopic pregnancies. The incidence of this rare disease significantly increased with application of assistant reproductive technology. The ectopic pregnancies usually occur in the fallopian tube, cervix, ovary, abdomen and previous cesarean scar. Because of the atypical clinical manifestations and the interference of intrauterine pregnancy, many cases could be missed diagnosis, misdiagnosed and delayed treatment, which always leads to serious complications. The treatment options for heterotopic pregnancy include expectant treatment, fetal reduction, surgery, and so on. The treatment should be individualized, based on patient′s preference, ectopic pregnancy site, clinical symptoms and signs. At the same time, it is still the treatment challenges how to avoid the impact of the treatment procedure of ectopic pregnancy on intrauterine pregnancy, for those patients who want to keep their intrauterine pregnancies. Related Articles | Metrics

Select

Infertility and Abnormal Development of Female Reproductive System HUANG He;TIAN Qin-jie 2016, 35 (3):  229-232.  Abstract ( 1543 )   PDF (788KB) ( 8027 )   The congenital anatomic disorders of the female reproductive organs occur frequently, which may be related to genetic mutation, developmental arrest, abnormal hormonal exposure, or exposure to environmental insults that exert their effects at critical stages of embryonic development. Although the genital anomalies are rare, they may affect the patients′ fecundity on sexual intercourse, ovulation, fertilization and implantation. Most of the patients present clinical manifestations of genital tract obstruction, amenorrhea and reproductive disorders. Surgical correction of deformity and assisted reproductive technology(ART) provide those infertility patients with genital anomalies new hope to bear children. The objective of treatment for those patients extends to relief the obstruction, to correct their genital anomalies, and to improve fertility and the life quality. Related Articles | Metrics

Select

Operational Strategies of Infertility Complicated with Uterine Myomas ZHAO Gui-jun;CHEN Rong 2016, 35 (3):  233-236.  Abstract ( 1402 )   PDF (881KB) ( 7950 )   The effects of myomas position, size and number on pregnancy, the operational indications of infertility complicated with uterine myomas, the effects of different operation ways on the pregnancy outcomes, and the optimal time of conceive after myomectomy were reviewed in this paper. The influence on fertility is in a decreasing order among submucosal, intramural and subserosal myomas, which means that the influence of submucosal myomas on fertility is greatest, and that the submucosal myomas with clinical symptoms should be removed while the subserosal myomas should not be recommended for operation. Operation treatment for the unexplained infertility should be based on the comprehensive evaluation on multiple factors and the strategy of individual-based treatment. Some new methods, such as the high-intensity focused ultrasound and the uterine-artery embolization, don′t fit for those women with pregnancy planning. Contraceptive time after operation should be adopted accordingly. It should be paid attention to the recurrence of myomas and the uterine rupture during pregnancy or labor after myomectomy. Related Articles | Metrics

Select

Uterine Cavity Lesions and Infertility GAO Shu-jun;SUI Long 2016, 35 (3):  237-240.  Abstract ( 1327 )   PDF (793KB) ( 7849 )   About 10% to 15% of infertile women are related to the uterine cavity abnormalities. The common uterine cavity lesions include endometrial polyps, submucous fibroids, uterine septum and intrauterine adhesions. Other lesions are often found including chronic endometritis, tuberculosis, retained products of conception, and so on. These lesions may result incavity morphological abnormalities, dysfunctional uterine contractility, abnormal uterine vascularization, chronic endometrial inflammation, and the impaired endometrial receptivity, which affect the fertilization, implantation and pregnancy maintenance. Diagnostic and operative hysteroscopy can significantly improve the outcomes of clinical pregnancy in those women with uterine cavity abnormalities and unexplained infertility. Related Articles | Metrics

Select

The Clinical Application of Anti-Müllerian Hormone in Female Reproduction LIU Zhen-xing;LI Hong 2016, 35 (3):  241-244.  Abstract ( 1573 )   PDF (802KB) ( 7874 )   The number and quality of oocyte decline with age. However, the fertility varies significantly even among women of the same age. Many measures have been developed to predict the response to ovarian stimulation and the reproductive potential. Anti-Müllerian hormone (AMH), a glycoprotein secreted by the granulosa cells of small growing follicles, can indirectly reflect the number of follicles in the primordial follicle pool and thus reflect the ovarian reserve. AMH as a practical indicator has been used to predict the ovarian response in IVF cycles, to predict the age of menopause, and to assess the ovarian reserve after iatrogenic injury as well. It has also been proposed as a surrogate for antral follicle count (AFC) in the diagnosis of polycystic ovary syndrome (PCOS). Related Articles | Metrics

Select

Ovulation Induction and Timed Intercourse for Outpatients and Treatment of Complications YANG Yi-hua;OU Jian-ping 2016, 35 (3):  245-250.  Abstract ( 1686 )   PDF (966KB) ( 7934 )   The ovulation induction(OI) and timed intercourse was the most simple and common assisted reproductive procedure for those infertile outpatients. Recent publications on this topic, combined with our clinical experiences, were reviewed, which is benefit to improve clinical practice for doctors of reproductive medicine. The following fileds were focused in this review: examination，valuation and preparation before OI, indication and contraindication of OI, the mechanisms and usage of common OI drugs, guidance of timed intercourse, as well as treatments of complications. Some important aspects were emphasized: to rule out the contraindications of pregnancy and OI before OI, to know well the mechanisms of common OI drugs and their dosages and administrations, to evaluate follicular growth and to predict ovulation time by means of various methods, and to prevent and treat timely OI complications. Related Articles | Metrics

讲座

Select

Seven Fundamental Principles of Tubal Microsurgery LI Tin-chiu;HOU Hai-yan;CHEN Ya-qiong 2016, 35 (3):  251-255.  Abstract ( 1605 )   PDF (826KB) ( 7883 )   Fallopian tube disease is an important factor of female infertility, including proximal tubal obstruction, distal tubal occlusion, hydrosalpinx, peritubal adhesions, tubal pregnancy and sterilization. Reproductive microsurgery and in-vitro fertilization and embryo transfer (IVF-ET) technology are two treatment modalities, being complementary to each other. Tubal microsurgery should be performed by experienced surgeons in microsurgery and laparoscopy. There are seven fundamental principles of tubal microsurgery as follows: ①to ensure appropriate indications; ②to select correct patients; ③to adopt the least invasive approach; ④to use microsurgery instruments; ⑤to minimize tissue damage; ⑥to ensure precise anatomy reconstruction; ⑦to reduce complication. In this way, the benefit of tubal surgery will be maximized by cautious operation and perfect procedure. Related Articles | Metrics

Select

Endometriosis with Infertility，Surgery or Assisted Reproductive Technologies? MAO Yun-dong 2016, 35 (3):  256-260.  Abstract ( 1474 )   PDF (867KB) ( 7919 )   Endometriosis is a common gynecologic disease with complex pathogenesis. It is very hard to treat. There are at least 25%-35% infertile female with endometriosis. Expectant treatment for infertility patient with endometriosis should not be recommend, and medication should also not be used for increasing the spontaneous pregnancy rate in many guidelines from Europe/USA/China. Surgery and assisted reproductive technologies (ARTs) are important treatment methods, but there are some debates in the strategy and opportune moment of treatment. In this review, we discussed some options on surgery and/or ART for infertility with minimal/mild endometriosis, surgery indication and opportunity in infertility with moderate/severe endometriosis, ovary protection during operation and effect of surgery on ovarian function, dispose after surgery and estimate of pregnancy rate, treatment for recurrent endometriosis with infertility, treatment for infertility with suspected endometriosis, pretreatment with GnRHa before ART in infertility with endometriosis. At last, we present our proposals on the treatment of endometriosis with infertility. Related Articles | Metrics

Select

Uterine Cavity Disease and Infertility MENG Yue-jin;YANG Jin-jin 2016, 35 (3):  261-264.  Abstract ( 1408 )   PDF (773KB) ( 7954 )   The incidence of female infertility is increasing year by year.Uterine cavity disease and fallopian tube lesion are two main factors of female infertility. The normal uterine cavity is the basic condition of successful pregnancy in both natural conception and assisted reproductive technology. However, a considerable number of doctors pay more attention to the examination and treatment of tubal patency, and not enough attention to the uterine cavity factors causing infertility, in their clinical diagnosis and treatment of infertility. The common uterine diseases causing infertility include endometrial polyps, intrauterine adhesion, uterine abnormalities, uterine fibroids, and so on. At home and abroad，the etiology of uterine diseases are basically similar，the different is the main cause of the order. Hysteroscopy, as a new and minimally invasive gynecological diagnosis and treatment technology, can be used to observe intuitively the uterine cavity, to understand whether there is a uterine cavity disease related to infertility, and to treat synchronously the abnormalities of uterine cavity. Hysteroscopy has become one of the preferred methods for examination and treatment of infertility. Related Articles | Metrics